Healthcare Provider Details

I. General information

NPI: 1164792602
Provider Name (Legal Business Name): GAIL LEE RATHBUN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL LEE GOETZ ARNP

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 S. POINTE BLVD.
FORT MEYERS FL
33919
US

IV. Provider business mailing address

6311 S. POINTE BLVD
FORT MEYERS FL
33919
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-0040
  • Fax: 239-275-7997
Mailing address:
  • Phone: 239-275-0040
  • Fax: 239-275-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9275512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: